Provider Demographics
NPI:1972534659
Name:MOUNTAIN EMPIRE OLDER CITIZENS, INC.
Entity Type:Organization
Organization Name:MOUNTAIN EMPIRE OLDER CITIZENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:PEASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-523-4202
Mailing Address - Street 1:1520 3RD AVE E
Mailing Address - Street 2:P. O. BOX 888
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-3114
Mailing Address - Country:US
Mailing Address - Phone:276-523-4202
Mailing Address - Fax:276-523-4208
Practice Address - Street 1:1501 THIRD AVENUE EAST
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3114
Practice Address - Country:US
Practice Address - Phone:276-523-4202
Practice Address - Fax:276-523-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251G00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009105077Medicaid
VA008700192Medicaid
VA008740259Medicaid
VA008770042Medicaid
VA010179238Medicaid
VA008730857Medicaid